COMPUTER ASSISTED CHARACTERIZATION OF RAPID REPETITIVE ELECTRICAL ACTIVATIONS IN THE PULMONARY VEINS DURING ATRIAL FIBRILLATION

2003 ◽  
Vol 13 (12) ◽  
pp. 3657-3663 ◽  
Author(s):  
P. LANGLEY ◽  
D. O'DONNELL ◽  
D. RAINE ◽  
S. S. FURNISS ◽  
J. P. BOURKE ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Electrophysiological Study ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Computer Assisted ◽  
Automatic Assessment ◽  
Cycle Lengths

Our group has described previously the identification of arrhythmogenic pulmonary veins by rapid local electrical activations during atrial fibrillation. We have now investigated an algorithm for automated computer detection of this phenomenon from catheter electrodes in the upper pulmonary veins and assessed its performance in identifying arrhymogenic veins. Ten patients with persistent atrial fibrillation scheduled for pulmonary vein isolation at this hospital were studied. Electrogram recordings in the upper pulmonary veins were recorded and analyzed. Arrhythmogenic veins were identified by focal activity during sinus rhythm at electrophysiological studies. Recordings were visually assessed by a cardiologist for the presence of rapid repetitive electrical activations during atrial fibrillation. An index of rapid repetitive electrical activity (RREA index), the ratio of the number of activations with cycle lengths in the range 50 ms to 100 ms to the number of activations with cycle lengths in the range 100 ms to 200 ms, was devised to describe the extent of such activity automatically. The index was assessed as a predictor of arrhythmogenic veins. Electrograms from 19 upper pulmonary veins were recorded. Rapid activity was evident in 15 veins by visual manual assessment. The mean (range) automatic RREA index was 0.07 (0 to 0.16) for those identified as having no such activity manually, and 0.83 (0.22 to 1.68) for those identified with rapid activity (p<0.0001). With a threshold of RREA index in the range 0.17 to 0.21, the identification of veins with rapid firing was exactly the same as for manual assessment. Eleven upper pulmonary veins were identified as arrhythmogenic during electrophysiological study, and the identification of these veins by both manual and automatic assessment of rapid repetitive electrical activations gave a sensitivity of 100% (11/11) and specificity of 50% (4/8). A technique for automatic characterization of electrogram cycle length has been demonstrated and could be used online as a tool for identifying candidate sites for pulmonary vein isolation in patients despite persistent atrial fibrillation.

scholarly journals Long-Standing Persistent Atrial Fibrillation Ablation: How Do You Perform? Left and Right Atrial Linear Ablation in Addition to Pulmonary Vein Isolation

2020 ◽  
Vol 33 (2) ◽  
pp. 106-114
Author(s):  
Michele Brunelli ◽  
Mark Adrian Sammut
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Low Voltage ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Right Atrial ◽  
Linear Ablation

Catheter ablation of long-standing persistent atrial fibrillation is not yet clearly defined with respect to endpoints, and different ablative strategies are offered to patients. Presented here is an approach aiming at biatrial debulking in the form of extensive linear ablation, specifically targeting areas of low-voltage complex fractionated electrograms, in addition to pulmonary vein isolation. Its main advantage is that it is not dependent on operator/system variability, since the strategy of isolating the pulmonary veins, superior vena cava and left atrial posterior wall together with achievement of bidirectional block during linear ablation provides objective endpoints that can consistently be reproduced.

Common ostium of the left pulmonary veins – to freeze or not to freeze – that was the question?

2017 ◽  
Vol 4 (45) ◽  
pp. 33-34
Author(s):  
Michał Orczykowski
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Clinical Results ◽  
Common Pulmonary Vein

Second-generation cryoballoon (CB2) - based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Nevertheless, the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV) are still a matter of debate. Commented paper by Heeger ChH, et al. analyzes this issue with some practical conclusions.

P1909Cryobaloon pulmonary vein isolation without pulmonary venography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Mengel ◽  
X W Lee ◽  
J Betts ◽  
R Ingram ◽  
H M Haqqani
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Intracardiac Echocardiography ◽  
Balloon Occlusion ◽  
Tactile Feedback ◽  
Single Operator

Abstract Introduction Cryoballoon pulmonary vein isolation (PVI) has been shown to be non-inferior to radiofrequency PVI and have several advantages including shorter procedure times. Cryoballoon PVI traditionally requires the use of occlusive pulmonary venography to assess for balloon position and contact however, some patients have contraindications to the use of iodinated radiocontrast. Purpose We assessed the feasibility of performing cryoballoon PVI without pulmonary venography. Methods Thirty-five initial consecutive patients with paroxysmal or persistent atrial fibrillation underwent cryoballoon PVI as a primary procedure under conscious sedation by a single operator. None had a contraindication to radiocontrast administration. Left atrial CT was obtained the day prior in all patients to assess pulmonary vein anatomy. Transeptal puncture was performed using 1–5 ml of contrast given the non-routine availability of intracardiac echocardiography. CT images obviated the requirement for pre-balloon deployment venography and pulmonary vein balloon occlusion was assessed by tactile feedback as well as the fluoroscopic appearance of balloon deformation (Fig 1.). If adequate temperature was not obtained with initial cooling during ablation, application was discontinued and the balloon repositioned. If repeated ablation did not result in sufficient cooling and vein isolation, pulmonary venography was utilised to assess adequacy of vein occlusion and sites of leak. Results The median age was 57 yrs with 69% male and 63% having paroxysmal AF. 137/138 pulmonary veins were successfully isolated with mean 1.77 ablations per vein. Median nadir ablation temperature was −45°C (range −62 to −30°C) with a median time to isolation of 36.5 seconds. 120/138 (87%) of veins were isolated without the use of contrast, however 18/138 required venography. Overall, 63% of patients had successful PVI without requiring any pulmonary venography. Average procedure time was 104 minutes. One patient sustained a mediastinal hematoma that resolved with conservative management. Median follow up was 3.6 months, with 74% of patients being free from atrial fibrillation at last follow up. Conclusion This study demonstrates that it is feasible to perform cryoballoon PVI without pulmonary venography in 87% of targeted veins. In this series, 63% of patients had successful 4 vein isolation without pulmonary vein contrast administration. This technique combined with imaging guided transeptal puncture can allow for truly contrast-less PVI in patients with severe contrast allergy or severe renal dysfunction.

scholarly journals Persistent atrial fibrillation presenting in sinus rhythm: Pulmonary vein isolation versus pulmonary vein isolation plus electrogram-guided ablation

2013 ◽  
Vol 106 (10) ◽  
pp. 501-510 ◽  
Author(s):  
Frederic A. Sebag ◽  
Najia Chaachoui ◽  
Nick W. Linton ◽  
Sana Amraoui ◽  
James Harrison ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation

scholarly journals B-PO04-071 ELECTROPHYSIOLOGICALLY-GUIDED PULMONARY VEIN ISOLATION AND SUBSTRATE IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION USING PRISM INDEX: A MULTICENTER STUDY

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S307-S308
Author(s):  
Ming-Jen Kuo ◽  
Yenn-Jiang Lin ◽  
Satoshi Higa ◽  
Akira Maesato ◽  
Sugako Ishigaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Multicenter Study ◽  
Persistent Atrial Fibrillation

scholarly journals B-PO04-105 ELECTROPHYSIOLOGICALLY GUIDED ADDITIONAL ABLATION AFTER CRYOBALLOON-BASED PULMONARY VEIN ISOLATION IN PATIENTS WITH LONG-STANDING PERSISTENT ATRIAL FIBRILLATION USING PRISM INDEX

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S321-S322
Author(s):  
Satoshi Higa ◽  
Yenn-Jiang Lin ◽  
Akira Maesato ◽  
Sugako Ishigaki ◽  
Chia-Hsin Chiang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation

Left atrial volume at MRI is the main determinant of outcome after pulmonary vein isolation plus linear lesion ablation for paroxysmal-persistent atrial fibrillation

2010 ◽  
Vol 11 (8) ◽  
pp. 593-598 ◽  
Author(s):  
Antonio Montefusco ◽  
Luigi Biasco ◽  
Alessandro Blandino ◽  
Yvonne Cristoforetti ◽  
Marco Scaglione ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Persistent Atrial Fibrillation ◽  
Atrial Volume ◽  
Main Determinant

Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation

2002 ◽  
Vol 11 (4) ◽  
pp. 83
Author(s):  
H. Oral ◽  
B.P. Knight ◽  
H. Tada
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation
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